Digitalization of the diabetic eye notebook: patient and physician perspectives on a smartphone application for diabetic retinopathy management.

PURPOSE: To evaluate patient and physician perspectives on the digitalization of the Diabetic Eye Notebook into a smartphone application, focusing on expectations, concerns, and potential benefits for the management of diabetic retinopathy (DR).

STUDY

DESIGN

A two-part prospective cross-sectional study comprising a multicenter patient survey and a single-center pilot usability and acceptability evaluation. (March-August 2024).

METHODS

Two independent surveys were conducted. In Study (A), 197 patients with diabetes from five institutions completed questionnaires assessing their awareness and use of the paper-based notebooks, willingness to adopt the application, and related expectations and concerns. In Study (B), a preliminary single-center pilot usability and acceptability evaluation was conducted in which eight physicians and ten patients at one institution used a beta version of the application and provided feedback on usability, functionality, and potential benefits.

RESULTS

In Study A: awareness and usage rates of the Diabetic Eye Notebook were 13.7 and 7.1%, respectively, both lower than those of the Japan Association for Diabetes Education and Care Coordination Notebook. Willingness to adopt the application was reported by 43.7% of patients. Patients willing to adopt the application were younger in the unadjusted comparison (mean age, 60.3 vs. 70.4 years; P<0.001), whereas the adjusted model showed a different direction for the age association, possibly reflecting confounding or a suppression effect related to routine smartphone-application use. Desired features included appointment reminders (47.3%), data sharing (32.2%), and visualization of clinical data (30.8%). Concerns included operational difficulty (64.4%) and data privacy (20.8%). In Study (B), physicians valued portability (75.0%) and improved communication (50.0%) but noted data entry burden (50.0%) and privacy issues (50.0%). Patients valued portability, treatment, history review, and improved communication (30.0% each), but reported privacy (40.0%) and usability (40.0%) concerns.

CONCLUSION

This study identified key expectations and concerns among patients and physicians regarding the digitalization of the Diabetic Eye Notebook. Although the application has the potential to overcome practical limitations of the paper-based format, usability for older adults and data security remain major challenges, underscoring the need for further refinement and prospective evaluation.